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Line 105: − − =Missed Concepts= − *Hemochromatosis diagnosis and association with HCC − *Paget disease diagnosis − *Complications of untreated scaphoid fracture (e.g. non-union, avascular necrosis) − *Chronic exertional compartment syndrome (worse with exertion) vs. tibial stress fracture (pain with standing) vs. shin splints − *Septic arthritis of the hip in an infant can lack fever, but presents with pseudo paralysis (due to pain), elevated WBCs, elevated CRP, and effusion. *Legg-Calvé-Perthes disease (idiopathic avascular necrosis of the hip) occurs in children aged 3-8, is insidious in onset, and does not have elevated inflammatory markers. − *Myotonic dystrophy is autosomal dominant, caused by CTG repeats with genetic anticipation. Classic form presents in adulthood with muscle weakness and myotonia (impaired muscular relaxation). Infantile presentation includes respiratory failure, hypotonia, inverted V upper lip, cataracts, poor feeding, and clubbed foot. Diagnosis is via genetic testing. − *FOOSH with "sail sign" (fat pad visible on xray), should be immobilized in a splint. − *Osteoporosis can lead to vertebral compression fractures after minimal trauma in elderly patients, manage with '''Tylenol/NSAIDs and PT.''' − *Indications for bariatric surgery include '''BMI > 40''', BMI > 35 with T2DM/OSA/HTN, BMI > 30 w/ T2DM resistant to treatment or metabolic syndrome. − *Raynaud is treated with '''dhp-CCBs like nifedipine'''. − *'''Lateral''' shoulder pain is the most common symptom in torn rotator cuff. − *Scoliosis that '''causes back pain, is rapidly progressive, or associated with neurological symptoms''' may be pathologic (e.g. spinal tumor). Most cases are idiopathic.
no edit summary
=Missed Concepts=
*Hemochromatosis diagnosis and association with HCC
*Paget disease diagnosis: bony pain, thickened cortex with sclerotic lesions on xray, elevated ALK, normal Ca.
*Treat Paget disease with alendronate (bisphosphanate) if patient has intolerable pain or involvement of weight-bearing bone.
*Complications of untreated scaphoid fracture (e.g. non-union, avascular necrosis)
*Chronic exertional compartment syndrome (worse with exertion) vs. tibial stress fracture (pain with standing) vs. shin splints
*Septic arthritis of the hip in an infant can lack fever, but presents with pseudo paralysis (due to pain), elevated WBCs, elevated CRP, and effusion. *Legg-Calvé-Perthes disease (idiopathic avascular necrosis of the hip) occurs in children aged 3-8, is insidious in onset, and does not have elevated inflammatory markers.
*Myotonic dystrophy is autosomal dominant, caused by CTG repeats with genetic anticipation. Classic form presents in adulthood with muscle weakness and myotonia (impaired muscular relaxation). Infantile presentation includes respiratory failure, hypotonia, inverted V upper lip, cataracts, poor feeding, and clubbed foot. Diagnosis is via genetic testing.
*FOOSH with "sail sign" (fat pad visible on xray), should be immobilized in a splint.
*Osteoporosis can lead to vertebral compression fractures after minimal trauma in elderly patients, manage with '''Tylenol/NSAIDs and PT.'''
*Indications for bariatric surgery include '''BMI > 40''', BMI > 35 with T2DM/OSA/HTN, BMI > 30 w/ T2DM resistant to treatment or metabolic syndrome.
*Raynaud is treated with '''dhp-CCBs like nifedipine'''.
*'''Lateral''' shoulder pain is the most common symptom in torn rotator cuff.
*Scoliosis that '''causes back pain, is rapidly progressive, or associated with neurological symptoms''' may be pathologic (e.g. spinal tumor). Most cases are idiopathic.
=Systemic Lupus Erythematosus=
=Systemic Lupus Erythematosus=
Autoimmune inflammatory condition caused by antibody-antigen deposition in various tissues.
Autoimmune inflammatory condition caused by antibody-antigen deposition in various tissues.
*Dx: CREST syndrome—Calcinosis, Raynaud's phenomenon, Esophageal dysmotility (GERD), Sclerodactly, and Telangiectasias. It involves the distal extremities and face only, is slowly progressive, has positive anti-centromere antibodies, a fair prognosis, and is associated with pulmonary hypertension. Diffuse scleroderma has generalized skin involvement, is rapidly progressive, has anti Scl-70 (topoisomerase I) antibodies, a poor prognosis, weaker association with calcinosis and telangiectasias, is associated with pulmonary interstitial fibrosis, and is more likely to trigger renal failure. '''Both can cause scleroderma renal crisis, which presents as acute malignant hypertension'''
*Dx: CREST syndrome—Calcinosis, Raynaud's phenomenon, Esophageal dysmotility (GERD), Sclerodactly, and Telangiectasias. It involves the distal extremities and face only, is slowly progressive, has positive anti-centromere antibodies, a fair prognosis, and is associated with pulmonary hypertension. Diffuse scleroderma has generalized skin involvement, is rapidly progressive, has anti Scl-70 (topoisomerase I) antibodies, a poor prognosis, weaker association with calcinosis and telangiectasias, is associated with pulmonary interstitial fibrosis, and is more likely to trigger renal failure. '''Both can cause scleroderma renal crisis, which presents as acute malignant hypertension'''
*Tx: '''ACEI (captopril is preferred) is 1st line for scleroderma renal crisis, even though ACEI are generally avoided in acute renal failure. Also give IV nitroprusside if there is concomitant malignant HTN'''
*Tx: '''ACEI (captopril is preferred) is 1st line for scleroderma renal crisis, even though ACEI are generally avoided in acute renal failure. Also give IV nitroprusside if there is concomitant malignant HTN'''